Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences.

OBJECTIVE To evaluate effectiveness of an exercise programme in a community setting for patients with low back pain to encourage a return to normal activities. DESIGN Randomised controlled trial of progressive exercise programme compared with usual primary care management. Patients' preferences for type of management were elicited independently of randomisation. PARTICIPANTS 187 patients aged 18-60 years with mechanical low back pain of 4 weeks to 6 months' duration. INTERVENTIONS Exercise classes led by a physiotherapist that included strengthening exercises for all main muscle groups, stretching exercises, relaxation session, and brief education on back care. A cognitive-behavioural approach was used. MAIN OUTCOME MEASURES Assessments of debilitating effects of back pain before and after intervention and at 6 months and 1 year later. Measures included Roland disability questionnaire, Aberdeen back pain scale, pain diaries, and use of healthcare services. RESULTS At 6 weeks after randomisation, the intervention group improved marginally more than the control group on the disability questionnaire and reported less distressing pain. At 6 months and 1 year, the intervention group showed significantly greater improvement in the disability questionnaire score (mean difference in changes 1.35, 95% confidence interval 0.13 to 2.57). At 1 year, the intervention group also showed significantly greater improvement in the Aberdeen back pain scale (4.44, 1.01 to 7.87) and reported only 378 days off work compared with 607 in the control group. The intervention group used fewer healthcare resources. Outcome was not influenced by patients' preferences. CONCLUSIONS The exercise class was more clinically effective than traditional general practitioner management, regardless of patient preference, and was cost effective.